tbuckley/cabot-search huggingface dataset:
Characterizing “no treatment” decisions in patients with advanced-stage cancers.
Authors: Ogheneyoma Akpoviroro, Oghenetejiro Princess Akpoviroro, Kristena Yossef, Myriam Castagne, Elga Rodrigues, Queeneth Uwandu, Brian Bolden, Wasique Mirza
Journal: Journal of Clinical Oncology (2022)

76 Background: Cancer (CA) is one of the leading causes of death worldwide. In 2020 CA was the second leading cause of mortality in the US. Novel treatments for various malignancies are discovered each passing year. Despite these advancements, some patients refuse to receive treatment. Our study focused on characterizing the group of patients with advanced malignancies who refused therapy. Methods: We performed a retrospective chart review of patients diagnosed with advanced malignancies, aged 18-75 years, between 01/01/ 2010 and 12/31/2015, who refused any therapy. We used Geisinger Health System’s data. Results: Our search provided 644 patients who met our inclusion criteria. The mean age of patients was 63.2 years (standard deviation (σ) 8.3). Female patients made up 40.4% (260/644), while 59.6% (384/644) were male. Most patients were Caucasian (96.9%, 624/644), 1.9% (12/644) were Black; 0.6% (4/644) were Asian, and 0.6% (4/644) were of unknown racial background. Marital status was evenly distributed with 50.0% (322/644) being married and 50.0% (322/644) being non-married. Most of the study population (52.3%, 337/644) had government-funded insurance at the time of CA diagnosis; 46.6% (300/644) had private insurance, and 1.1% (7/644) had no insurance. Stage 3 disease, according to American Joint Committee on Cancer staging was noted in 21.1% (136/644), while 78.9% (508/644) had stage 4 disease. The mean BMI was 28.2 (σ 8.3). Most patients were either overweight or obese (60.6%, 350/577; 67 patients did not have data on BMI available). A history of cigarette smoking was present in 73.0% (438/600). Adenocarcinomas (323/639, 50.5%) were the most prominent histological subtype. The most common site of malignancy was the respiratory system (220/644, 34.2%). Only 9.6% (62/644) of patients had a history of previous CA, while a family history of CA was present in 29.5% (190/644). Most patients (62.1%, 400/644) had a Charleston Comorbidity Index (CCI) &gt; 5; the mean CCI was 6.4 (σ 3.7). In 17.1% (110/644) a palliative medicine referral was made. Substance use disorders were present in 23.8% (153/644); 14.4% (93/644) had a history of depression, and anxiety 10.1% (65/644). Conclusions: Male patients made up a larger proportion of the group of advanced-stage patients who declined therapy. The racial distribution in this group of patients appeared to reflect the local population. Most patients who refused therapy had stage 4 disease, and they appeared to have severe underlying comorbidities, with an average CCI &gt;5. Despite treatment refusal, a surprisingly low percentage of patients were referred to palliative medicine.[Table: see text][Table: see text]
The Together, Equitable, Accessible, Meaningful (TEAM) cancer care for sexual and gender minority (SGM) patients: A pilot training evaluation.
Authors: Mandi L. Pratt-Chapman, Sylvia Shirima
Journal: Journal of Clinical Oncology (2022)

366 Background: SGM persons face barriers to health care which may contribute to disparities in cancer outcomes. SGM-specific health coverage in healthcare professional schools is minimal and inconsistent. The TEAM SGM Training aimed to address the unique health care needs of SGM people diagnosed with cancer by improving healthcare professional knowledge and clinical preparedness and changing in-clinic behaviors as well as organizational policies. Methods: Seven teams of healthcare professionals (n = 28) were invited to participate in the pilot. Each team participated in a 13-week, 17.5-hour training curriculum and developed an action plan and progress was assessed at three- and six-months post-training. Change in provider confidence, attitudes, knowledge, and behaviors were measured using an investigator-created and validated survey. Paired sample t-tests were used to examine differences from baseline to post-training learner assessment. Teams participated in entrance and exit interviews to identify drivers and barriers to implementation. Independent samples t-tests were used to examine differences in patient experiences at baseline in each organization and at 26 weeks post baseline data collection. Results: Of the 28 learners who started the training, 27 learners completed the training. All learners (n = 28) completed baseline assessments, and n = 22 completed post-intervention assessments. Statistically significant improvements were found in four of five factors: Environmental Cues ( t(21) = 2.56, p =.018), Knowledge ( t(21) = 2.15, p =.043), Clinical Preparedness ( t(7) = 3.89, p =.006), and Clinical Behaviors (t(21) = 2.48, p =.022). For patient experience, n = 90 baseline surveys and n = 187 post-intervention surveys were collected across two healthcare settings. Results were null. All teams made progress at six months on action plans. Facilitators and barriers included; resources and buy-in from leadership and limited staff engagement respectively. Conclusions: Synchronized standardized training can improve knowledge, clinical preparedness, and clinical behaviors for SGM-affirming care. While realistic goals are critical to early success, ongoing technical assistance and supportive institutional structures are important for successful organizational change.
Time trends of overall survival and other outcomes in patients with mHSPC: An observational study of U.S. EHR data (TIMES).
Authors: Neal D. Shore, Rana R. McKay, Mark Preston, Justin R. Gregg, Simpa Samuel Salami, Ashley Ross, Amanda Bruno, Shankar Srinivasan, Jorge A. Ortiz, Niculae Constantinovici
Journal: Journal of Clinical Oncology (2022)

403 Background: Metastatic hormone-sensitive prostate cancer (mHSPC) initially responds to androgen deprivation therapy (ADT), but unfortunately most patients (pts) develop metastatic castration-resistant prostate cancer (mCRPC) within 1–3 years. The CHAARTED trial showed a clear benefit of adding docetaxel (DTX) to ADT, improving median overall survival (OS) by 10.4 months (mo). ARASEC is a single-arm US study evaluating darolutamide + ADT in 200 pts with mHSPC, who will be matched using patient-level data to the ADT alone arm of CHAARTED. The TIMES study evaluated a potential time bias in treatment patterns and clinical outcomes in pts with mHSPC receiving therapy before or after the OS analysis of CHAARTED was reported. Methods: This retrospective study used Flatiron Metastatic Prostate Cancer Core Registry data from January 1, 2013, to June 30, 2020, divided into two cohorts: before and after June 30, 2016 (cohort 1 pre-CHAARTED; cohort 2 post-CHAARTED). Differences in OS and time to mCRPC were assessed using Cox proportional hazard models controlling for baseline characteristics, including age, initial mHSPC treatment, Gleason score, and time from prostate cancer diagnosis to mHSPC. The test for equivalence used hazard ratio (HR) confidence limits of 0.80 to 1.25 at a 2-sided 95% level. Results: Data from 9256 pts with mHSPC (cohort 1 4503; cohort 2 4753) were analyzed. Median age was 73 years in both cohorts. M1 status at initial diagnosis was 55% in cohort 1 and 60% in cohort 2. Other clinical characteristics and laboratory values were generally similar. mHSPC treatments are shown in the Table. Use of DTX or novel anti-hormonal agent (NAH) increased from cohort 1 to cohort 2. The percentage of pts receiving ADT alone or with other treatment (supportive care) remained essentially the same (25.7% and 26.5%, respectively), and no mHSPC treatment was identified for 32.9% and 21.7% of pts in cohorts 1 and 2, respectively. Median OS was 5.4 months longer for cohort 1 (43.7 mo) vs cohort 2 (38.3 mo). In multivariate analyses adjusting for baseline variables, cohort 2 had poorer survival, with an HR upper confidence limit outside the predefined limits for equivalence (HR 1.18; 95% CI 1.09, 1.28). The HR for time to mCRPC fell within the predefined limits (HR 1.16; 95% CI 1.09, 1.23). Conclusions: Changes in treatment patterns were observed following CHAARTED, but use of DTX or NAH increased only to 32%, despite level I evidence and guideline recommendations. Real-world mHSPC patient outcomes, which are influenced by multiple factors, have changed minimally during the past 5 years, suggesting that use of the CHAARTED ADT alone arm as a comparator for ARASEC has a low risk of historical time bias.[Table: see text]
Innovation in recruitment and curricular design for diversity, equity, and inclusion (DEI) education for hematology-oncology (HO) trainees.
Authors: S. M. Qasim Hussaini, Samuel Rosner, Erica C. Nakajima, Marcus Messmer, Tanyanika Phillips, Rakhi Prakash Naik, Ross C. Donehower, Kristen Marrone
Journal: Journal of Clinical Oncology (2022)

179 Background: Alongside persistent disparities in healthcare outcomes in HO, there is an inability to adequately recruit, maintain and promote a diverse and inclusive work force nationwide. To our knowledge, a structured approach to DEI education/recruitment in HO training is lacking. We sought to establish a longitudinal curriculum aimed at educating HO trainees in structural barriers impacting cancer equity and developing tools to enhance Underrepresented in Medicine (URiM) recruitment. Methods: Trainee-led DEI framework was presented to program leadership and officially adopted into the curriculum for the 2021-22 academic year. This consisted of initiatives across 4 domains: 1. Curricular Development (emphasis on disparities during trainee orientation, didactic lectures on cancer disparities, financial toxicity, workforce diversity, pandemic impact on cancer inequities) ; 2. Recruitment &amp; Retention (implicit bias training, targeted recruitment from HBCUs, trainee-led discussions on enhancing recruitment); 3. Engagement &amp; Mentorship (local community mentorship within institution, external mentorship through ASCO URM MSR program); 4. Disparities Research (career guidance sessions with invited faculty, development of registry-based studies to evaluate disparities). Impact of new curriculum was measured through anonymous surveys, at 1, 7, and 12 months during the academic year. A 5-point Likert scale (strongly disagree to strongly agree) was utilized. Results: At baseline, surveyed trainees were predominantly PGY5 (33%), ages 31-40 (66%), and self-identified as White or Caucasian (47%). Over the academic year, trainee recognition of structural barriers that prevented oncologic care delivery increased. More trainees felt departmental/fellowship-wide DEI efforts were transparent and impactful leading to quantifiable changes, and creation of new mentorship opportunities. Trainees rated the following as most helpful to address biases in the workplace: opportunities to mentor minority high school/college-level students, implicit bias training, and formal lectures. Anonymous qualitative feedback from fellows favored small group discussions and encouraged a top-down approach to promoting diversity in leadership. One trainee-mentored URiM medical student presented work at the ASCO annual conference on cancer disparities, while program leadership efforts led to incoming trainee class comprised of 25% URiM. Conclusions: We demonstrate feasibility of a longitudinal DEI curriculum in HO trainee education and recruitment that raises awareness and creates opportunity for URiM. Future efforts will build on this curriculum utilizing trainee feedback and departmental buy-in with the goal of building an oncologic workforce that better reflects the patients we care for.
Clinical symptoms and conditions leading to metastatic non–small cell lung cancer diagnosis in patients with and without targeted mutations.
Authors: Jon Apple, Anne Shah, Janakiraman Subramanian, SAAD ASLAM, Nicole Engel-Nitz, Laura A Weber, John White
Journal: Journal of Clinical Oncology (2022)

401 Background: This study compares patient characteristics, clinical conditions, the prevalence and timing of lung cancer symptoms, and diagnostic procedures from onset to mNCSLC diagnosis for patients with and without targetable mutations. Methods: This was a retrospective claims analysis of Medicare Advantage and commercially insured adult mNSCLC patients (11/01/2012 - 01/31/2020) with continuous health plan enrollment (24 months pre-index and ≥2 months post-index) around the index date (mNSCLC diagnosis). Patients on targeted therapy post-diagnosis were assigned to the targeted group (TG); non-targeted group (NTG) otherwise. Twenty pre-specified lung cancer related symptoms, baseline comorbidities, and diagnostic procedures were examined in the pre-index period. Results: The study comprised 2,940 patients (TG: 390; NTG: 2,550); TG had lower mean age (65.8yrs vs 69.2yrs; p &lt; 0.001), more females (59.5% vs 50.6%; p = 0.001), and lower tobacco use (55.9% vs 92.5%; p &lt; 0.001). Mean TG Charlson score was 1.37 in the TG vs 1.93 in the NTG; p &lt; 0.001. There were no significant differences in prevalence of any lung cancer related symptoms (TG 81.8% vs NTG 83.5%; p = 0.4). When comparing the 20 individual, pre-specified lung cancer related symptoms (cough, dyspnea, hemoptysis, etc.), there were also no significant differences between the study cohorts. For patients with symptoms, the mean times from the first symptom to mNSCLC diagnosis were similar (TG: 339.3 days; NTG: 363.1 days; p = 0.13)(Table). There were significant differences in the proportion of patients with comorbidities between study cohorts (TG 64.4% vs NTG 73.5%; p &lt; 0.001). Among patients within TG, there was higher prevalence of pleural effusion (22.1% vs 12.6%; p &lt; 0.001) and lower prevalence of COPD (17.7% vs 50.8%; p &lt; 0.001). For diagnostic procedures, patients in TG had fewer imaging procedures than NTG (Chest x-ray 67.7% vs. 74.1%; p = 0.008, CT scan 57.2% vs 63.5%; p = 0.016, PET scan 19.0% vs 27.1%; p &lt; 0.001); and a longer mean time from first symptom to first imaging procedure (TG: 220 days; NTG: 184 days; p = 0.015)(Table). Conclusions: Patients with and without targetable mutations may differ by some patient characteristics, but they may not differ by presentation and type of lung cancer related symptoms leading up to diagnosis.[Table: see text]
Liquid biopsy detection of tumor shed in cancers for which molecular profiling is best practice.
Authors: Pashtoon Murtaza Kasi, Caroline Weipert, Julie Kaylor
Journal: Journal of Clinical Oncology (2022)

412 Background: Technology and innovation in genomic profiling provides an opportunity to improve the outcomes of advanced solid cancer patients including some cancer agnostic approved therapies, and biomarker analysis is recommended within NCCN guidelines for 15 solid cancers. Tissue-based molecular profiling may not be efficient or feasible for many patients due to factors such as fitness for procedure, timeliness to treatment, and sample exhaustion, leading to healthcare disparities. Despite robust validation and regulatory approval for use in genomic profiling across all advanced solid tumors, circulating tumor DNA (ctDNA) or “liquid biopsy” is included within NCCN guidelines for 9 solid cancers. The utility of ctDNA based profiling in additional cancers for which molecular analysis is recommended is contingent upon the ability to reliably detect tumor shed and biomarkers of interest. Methods: Results were analyzed for a large nationwide cohort over 40,000 patients seen across community and academic settings receiving Guardant360 CDx or Guardant360 (Guardant Health, Redwood City, CA) in a 6-month window to evaluate detection of ctDNA, or tumor shed, among cancers for which guidelines do and do not currently include liquid biopsy. Results: Tumor shed was detected in 83%-92% (median 89%) of cancers for which guidelines include liquid biopsy, and 73%-94% (median 88%) for those without guideline inclusion for liquid biopsy. The detection of tumor shed was similar among cancer types with and without liquid biopsy inclusion in guidelines (p value = 0.5014; two-tailed t-test). Conclusions: The non-invasive nature of liquid biopsy, rapid turnaround, and sufficient tumor shed (as shown by results of this study) further support the inclusion of liquid biopsy in NCCN guidelines when molecular profiling is indicated. For tumors where it may replace the need for tissue biopsy acquisition, a plasma-first approach incorporating a liquid biopsy can reduce the financial toxicity as it would be more efficient and cost-effective.[Table: see text]
Remote triage and the oncology patient experience.
Authors: Blake Hoegger, Sydney Townsend, Lance Ortega, Sabrina Q. Mikan, Debra A. Patt, Holly Books
Journal: Journal of Clinical Oncology (2022)

297 Background: Investments in infrastructure to enhance care delivery are often partnered with practice participation in alternative payment model contracts and innovative care delivery models. Oncology nurses routinely are physically located in a cancer practice. We sought to understand the impact of centralizing resources to work remotely building upon triage pathways already in place on staffing and symptom call resolution with the goal of optimizing outpatient symptom management and patient satisfaction. Due to a national RN shortage and a historical high number of RN vacancies in oncology, we thought this this innovative staffing solution may attract, retain, and elevate the role of RNs. Methods: A needs assessment was conducted to evaluate call volumes, staff levels and duties. A gap analysis was performed to determine which duties would be assigned to remote triage versus in person staffing. Some sites had triage; all sites upgraded to new optimization of assessment and management. Standardized evidence based care and communication pathways were implemented. RNs were trained to follow structured workflows for call ticket resolution. A regional pool supported primary triage RNs who were assigned to each site. The model allowed for flexible staffing while building and maintaining relationships with local providers. Additionally, remote triage RNs were given the opportunity to augment their assessment with audio/visual telehealth as needed. Results: In the first 4 months, 9 pilot sites decreased symptom management time by 50%; 1 site decreased by 70% (over 120 minutes down to 27 minutes). Since remote triage began, average resolution times reduced from 2.52 hours to 1.31 hours. One pilot site had an in-person triage position posted and attracted 4 applicants over 4 weeks. When the position was converted to a remote role, 38 applications were received in 1 week. Offering remote triage positions allowed RN recruitment from other states and gave tenured RNs within the organization an attractive new work model. Conclusions: Remote RN work is an attractive opportunity for RNs allowing for broader recruitment of candidates. Removing triage RNs from the clinic site allows them to focus on triage resolution and as a result call resolution times decreased substantially. Standardized communication pathways were developed, rolled out, and optimized in both virtual and in-person Triage RN roles statewide. Adherence to these communication pathways is critical to ensuring timely symptom management resolution and a sustainable workforce.
Quality initiative (QI) to improve molecular testing in newly diagnosed (ND) stage 4 non-small cell lung cancer (NSCLC-4): An Integra Connect (IC) database study.
Authors: Robert E. Smith, Mike Gart, Rushir J. Choksi, Daniel P. Petro, Jeffrey A. Scott, Prateesh Varughese, Matt Stockton
Journal: Journal of Clinical Oncology (2022)

304 Background: In August 2019 IC partnered with University of Pittsburg Medical Center (UPMC) on a QI aimed at improving outcomes in stages 3 and 4 NSCLC. This report details the findings, interventions, and results in the stage 4 cohort to date. Guidelines advocate broad molecular profiling and completion of biomarker testing prior to initiation of initial therapy (KF Mileham,2022). However, real world data has shown a high rate of treatment initiation without biomarker testing due to low rate of testing and, if tested, treatment prior to results reporting (H West,2021; J Nicholas, 2021) in this disease state having a 5-year survival of only 7% (N Howlander). Based on analysis of the US Oncology Network it was found that only 46% of patients (pts) with metastatic NSCLC received testing for PD-L1, EGFR, ALK, ROS1, and BRAF-V600E (J Nicholas, 2021). Methods: By querying the UPMC and IC databases, 910 patients (pts) with ND NSCLC-4 were identified who received an initial line of therapy, excluding squamous carcinoma pts unless documented never-smokers, during 1/1/2017- 12/31/2021. Date of EGFR test ordered, date of test result report to electronic health record, and date of treatment initiation were captured. Also included were test orders for the NCCN recommended biomarker panel of PD-L1, ALK, ROS1, BRAF, RET, MET, and NTRK. The data were evaluated in three time periods for the QI: Phase 1 of 1339 days (1/1/2017-8/31/2020) for baseline, Phase 2 of 122 days (9/1/2020-12/31/20) post physician leadership intervention, and Phase 3 of 516 days (1/1/2021-5/31/2022) performance measurement period. Baseline and on-going measurement of testing metrics was performed with physician leadership intervention for identified gaps in care. Additionally, surveys were implemented to assess caregiver perceptions. The use of chart curation and software-based monitoring tools powered by IC enabled providers to understand current levels of testing and track performance over time. Results: Median age was 68 (range 36 - 89) and 49% male. As shown in Data Table, EGFR testing at baseline was 94% and increased to 98%. Testing of the entire biomarker panel noted above increased from 52% baseline to 70% at this point in Phase 3. While only 72% had treatment initiated after EGFR result at baseline, this improved to 83% during Phase 3. Conclusions: This QI led to improvement in rates of broad biomarker testing and initiation of treatment only after results were made available in this NSCLC-4 population. While this initiative was not designed to evaluate outcomes, one would expect outcome improvement over baseline with higher guideline adherence.[Table: see text]